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Keeping pace with robotics technology

Publish Date: 10/31/2012

Three weeks ago the first single incision robotic-assisted cholecystectomy in Boston was successfully completed at Beth Israel Deaconess Medical Center (BIDMC).  To keep pace with evolving demand for robotic surgery, in the last year BIDMC has added three service lines to their existing four when they purchased a second robot with a simulation module to expand their robotic training and credentialing.

Helping lead the expansion of BIDMC’s robotics program is Clinical Advisor Joyce Mechaber, BSN, RN. She says this rapid growth is very doable with the right resources in place, including:

  1. Physician champions who drive the adoption of robotics technology and bring in patients.
  2. A robotic team of 3-4 nurses and 3-4 surgical technologists (enough to ensure a full staff for any robot program) who are skilled in laparoscopic and open procedures for their service line and who will later serve as robot super users.
  3. Detailed robotic competencies for scrub and circulator tailored to the specific robot platform used at a site.
  4. Trained sterile processing professionals skilled in processing robot instrumentation.
  5. A close working relationship with the robot clinical support personnel and access to online resources for shaping competencies and training.
  6. Team briefings before any first time procedures to review instrumentation and patient cart (robot) position.  Preoperative briefings amongst the robot team are a daily occurrence at BIDMC.

“You have to have people involved who believe in the technology and understand what it is about—a robot is really just a tool that can support a good outcome for the patient,” Mechaber says. “The robot is also a big patient satisfier. The increased precision of this instrumentation and 3-D visualization support a better surgical outcome with decreased blood loss and infection.”

BIDMC robotic service lines include: GU, GYN oncology and GYN women’s health, hepatobilliary, thoracic, colorectal, and general surgeries. Mechaber has learned that training tailored for specific procedures is needed for every member of the robotic surgical team, including residents and sterile processing professionals.

“Shaping effective and efficient pick lists is very important,” Mechaber says. For her teams, this has been an evolving process that begins will pulling a surgeon’s preference for their laparoscopic procedure, adding the robotic instruments and then streamlining down to what is truly needed. 

Mechaber has worked closely with her educator colleagues and her robot rep to develop detailed robotic competencies that address all aspects of the scrub and circulator’s respective roles during a robotic procedure, including knowledge needed to troubleshoot the robot and convert to an open case.

“Robotic technology is rapidly evolving, I truly believe this is the future of surgery,” Mechaber stresses.

At age 67, she says age cannot be a barrier for any perioperative nurse with an interest in robotic surgery. “I am the older nurse who shouldn’t be interested in any of this, but I think robotic surgery is fascinating. I was a big proponent of this from the beginning and I think a lot of my enthusiasm has carried over. It’s so interesting to see where the technology can take you!”

Additional Resources 

Explore the online training and support resources from Intuitive Surgical, Inc. that BIDMC uses to tailor their education for all robot team members.

Find practice recommendations for robotic surgery in AORN Recommended Practices for Minimally Invasive Surgery.

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